Calabrese Sarah K, Magnus Manya, Mayer Kenneth H, Krakower Douglas S, Eldahan Adam I, Hawkins Lauren A Gaston, Underhill Kristen, Hansen Nathan B, Kershaw Trace S, Betancourt Joseph R, Dovidio John F
1 Department of Psychology, George Washington University , Washington, District of Columbia.
2 Department of Chronic Disease Epidemiology, Yale School of Public Health , New Haven, Connecticut.
AIDS Patient Care STDS. 2017 Apr;31(4):196-204. doi: 10.1089/apc.2017.0002.
Despite the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP) and evidence that most PrEP users do not engage in risk compensation (i.e., increased risk behavior due to a perceived decrease in HIV susceptibility), some healthcare providers report patient risk compensation to be a deterrent to prescribing PrEP. Overcoming this barrier is essential to supporting PrEP access and uptake among people at risk for HIV. To inform such efforts, this qualitative study explored PrEP-related risk compensation attitudes among providers with firsthand experience prescribing PrEP. US-based PrEP providers (n = 18), most of whom were HIV specialists, were recruited through direct outreach and referral from colleagues and other participants. Individual 90-min semistructured interviews were conducted by phone or in person from September 2014 through February 2015, transcribed, and thematically analyzed. Three attitudinal themes emerged: (1) providers' role is to support patients in making informed decisions, (2) risk behavior while taking PrEP does not fully offset PrEP's protective benefit (i.e., PrEP confers net protection, even with added behavioral risk), and (3) PrEP-related risk compensation is unduly stigmatized within and beyond the healthcare community. Participants were critical of other healthcare providers' negative judgment of patients and reluctance to prescribe PrEP due to anticipated risk compensation. Several providers also acknowledged an evolution in their thinking from initial ambivalence toward greater acceptance of PrEP and PrEP-related behavior change. PrEP providers' insights about risk compensation may help to address unsubstantiated concerns about PrEP-related risk compensation and challenge the acceptability of withholding PrEP on these grounds.
尽管有证据表明HIV暴露前预防（PrEP）有效，且大多数PrEP使用者不会出现风险代偿（即因认为感染HIV的易感性降低而增加风险行为），但一些医疗服务提供者报告称，患者的风险代偿是阻碍开具PrEP处方的因素。克服这一障碍对于支持有HIV感染风险的人群获得并采用PrEP至关重要。为了为这类工作提供信息，这项定性研究探讨了有PrEP处方第一手经验的医疗服务提供者对与PrEP相关的风险代偿的态度。通过直接宣传以及同事和其他参与者的推荐，招募了美国的PrEP医疗服务提供者（n = 18），其中大多数是HIV专家。从2014年9月至2015年2月，通过电话或面对面方式进行了为期90分钟的个人半结构化访谈，访谈内容进行了转录并进行了主题分析。出现了三个态度主题：（1）医疗服务提供者的职责是支持患者做出明智的决定；（2）服用PrEP期间的风险行为并不能完全抵消PrEP的保护益处（即即使存在额外的行为风险，PrEP仍能提供净保护）；（3）医疗保健社区内外对与PrEP相关的风险代偿存在过度污名化现象。参与者批评了其他医疗服务提供者对患者的负面判断以及因预期的风险代偿而不愿开具PrEP处方的行为。几位医疗服务提供者还承认，他们的想法已从最初的矛盾心理演变为更能接受PrEP以及与PrEP相关的行为改变。PrEP医疗服务提供者对风险代偿的见解可能有助于解决对与PrEP相关的风险代偿的无端担忧，并质疑基于这些理由拒绝开具PrEP处方的可接受性。
